Current Journal of Neurology
Volume:11 Issue: 3, Summer 2012

Prevalence of electrophysiological abnormalities in patients with lumbosacral radiculopathy was evaluated. A cross-sectional study was performed on 97 consecutive patients with the clinical diagnosis of lumbosacral radiculopathy. Complete neurological examinations and standard electrophysiological evaluation was performed on the patients. Patients under study had the mean age of 46.4 ± 13.1 years (mean ± standard deviation). There were positive MRI findings in 64% of the patients. In 43% L5 root and in 40% S1 root was involved. Abnormal electrophysiological findings were recorded in 82% of the patients. In patients with pretibial muscle weakness, there were significant abnormalities recorded in compound motor action potential (CMAP) amplitude of the common peroneal nerve. There was significantly increased frequency of electrophysiological abnormalities in the presence of chronic clinical symptoms (P = 0.001). The 82% positive findings in electrophysiological studies in the diagnosis of lumbosacral radiculopathy make it an efficacious tool in the evaluation of the patients suffering from lumbosacral radiculopathy.

Disease-modifying drugs (DMDs) are a significant expenditure for treating multiple sclerosis (MS). However, there is limited report on assessment of the cost-utility of DMDs compared with symptom management in the presence of long-term data. This study aimed to assess the lifetime cost-utility from the Iranian healthcare perspectives of 4DMDs relative to symptom management alone in patients with relapsing-remitting multiple sclerosis using evidence from long-term published studies. A Markov model was developed with patients transitioning through health states based on Kurtzke’s expanded disability status scale.Patient costs included drug costs, other medical and lost worker productivity costs. Patient quality of life was considered in the form of utilities. Costs were valued in 2011 USD, and were discounted at 7.2% per annum. Various parameters and assumptions were tested in sensitivity analyses. Total costs per patient over the time horizon of a patient’s lifetime were estimated at 20285, 144194, 299279, 251255 and 69796 USD for symptom management, Avonex, Betaferon, Rebif and CinnoVex, respectively. As a result, the incremental cost per quality adjusted life years (QALY) for patients receiving Avonex, Betaferon, Rebif and CinnoVex was 607397, 1374355, 1166515 and 1010429 USD, respectively, when compared with symptom management. The results were sensitive to changes in time horizon, disease progression and drug costs. DMDs in relapsing-remitting MS patients was associated with increased benefits compared with symptom management, albeit at higher costs. Because patients receiving Avonex incurred slightly higher QALYs than patients receiving other DMDs, treatment with Avonex dominates other DMDs in Iran.

Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients. The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied. After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides. The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients.

Multiple sclerosis (MS) is a neurological disease with fatigue as most prevalent symptom. Psychopathological symptoms, physical and mental dysfunctions and body mass abnormalities potentially could deteriorate fatigue. Thus, in this study, we aimed at evaluating the effect of these factors on fatigue severity of MS patients.

In this cross‐sectional study, 162 patients with mean age of 34.1 ± 9.4 (16-58 years) were recruited by consecutive sampling. All the patients, after completing demographic information were evaluated using Persian versions of Fatigue Severity Scale (FSS), depression, anxiety and stress scale (DASS-21), and short form Health Survey Questionnaire (SF-36).

Correlation analysis showed a significant relationship between fatigue severity and depression, anxiety, stress, physical component summary (PCS) and mental component summary (MCS) (P < 0.01). Findings of path analysis demonstrated that PCS is the only variable which has a direct effect on fatigue severity (β = -0.278, P < 0.05). Moreover, the strongest standard coefficient (β) belonged to cause and effect relationship between MCS and depression (β = -0.691, P < 0.0001).

Present study made the role of psychopathological symptoms and physical and mental dysfunctions prominent in exacerbation of fatigue severity. Moreover, we can refer to more sensible effect of physical dysfunction related to life on fatigue.

It is still a challenge to find an effective treatment for tinnitus. The aim of this study was the evaluation of carbamazepine and oxcarbazepine effects on tinnitus. In a randomized double–blind clinical trial, 57 patients who were visited in a university hospital due to chronic non-pulsatile tinnitus, were randomized in three groups and treated with carbamazepine (300-600 mg/day), oxcarbazepine (450-900 mg/day) and placebo for 12 weeks. Visual analogue scale (VAS) and tinnitus severity index (TSI) were measured in all subjects in the beginning and at the end of the 8th and 12th weeks of the trial. Data was analyzed by repeated measure analysis, paired and independent t-test. Among 51 participants who completed the trial course (28 men, 23 women), carbamazepine, oxcarbazepine and placebo decreased tinnitus severity in 56.6%, 46.2% and 38.5% of patients according to VAS, and in 61.1%, 58.8% and 50% of patients according to TSI, respectively. The effects of carbamazepine and oxcarbazepine were better in the first 8 weeks of treatment. However, their effect on tinnitus did not show any statistical difference in comparison with placebo (P = 0.34, P = 0.28). Carbamazepine and oxcarbazepine are not more effective than placebo in decreasing tinnitus severity.

Vertebrobasilar arterial territory nourishes one-quarter of human brain. It constitutes some vital and strategic parts of the central nervous system. A number of keywords (vertebral, basilar, artery, and territory) were searched in MEDLINE (Ovid and PubMed) as well as Google, ProQuest, Scopus, Cochrane Library, and Science Direct online electronic search engines. Only articles containing all keywords were included. The final search was performed on October, 1, 2012. We also reviewed archives of libraries in Mashhad University of Medical Sciences (Iran) for all anatomy, embryology, neurology, and neuroscience books and journals about vertebrobasilar arterial territories. The vertebrobasilar arterial (VA) system has a high incidence of variations, anomalies, and persistent fetal vessels. Two important anatomic facts explain why VA origin lesions seldom cause chronic hemodynamically significant low flow to the vertebrobasilar system. First, the VAs are paired vessels that unite to form a single basilar artery. Second, the extracranial VA gives off numerous muscular and other branches as it ascends in the neck. Thus, in the VA system, there is much more potential for development of adequate collateral circulation. Even when there is bilateral occlusion of the VAs at their origins, patients do not often develop posterior circulation infarcts. VA origin disease is more benign than ICA origin disease from hemodynamic aspect. This important point could make influence in therapeutic interventional decisions in asymptomatic VA origin stenosis.

Paget’s disease is a focal bone disorder manifested as bone overgrowth and disrupted bone integrity as a result of accelerated bone remodelling rate. Rarely, Paget’s disease of the base of the skull results in hydrocephalic dementia, and the triad of normal pressure hydrocephalus syndrome is a much more scarce entity.Case Report: Herein, we report an elderly woman who presented in Imam Khomeini Hospital, Tehran, Iran, with normal pressure hydrocephalus syndrome due to Paget’s bone disease. Furthermore, we have reviewed relevant previous studies Paget’s disease can be presented as normal pressure hydrocephalus syndrome.

Initial symptoms of multiple sclerosis (MS) may be varied and nonspecific. We tried to find the frequency distribution of the first clinical symptoms in Iranian patients with MS. In a case series study, 1130 patients with definite diagnosis of MS who had been referred to three referral university hospitals of Tehran, Iran were enrolled. The patients and medical records were reviewed for neurological history to find the first symptom at presentation. Of total, 884 (78.2%) patients were females and 246 (21.8%) were male. The mean±SD age of patients was 31.4±9.1 years. The most common initial symptoms were motor in 492 (43.5%), ocular in 366 (32.4%), cerebellar in 91 (8.1%), sensory in 76 (6.7%), cranial nerve involvement in 51 (4.5%) and fatigue in 23 (2%) of patients. There was no difference between female and male patients in first clinical symptoms (p>0.05). The motor symptoms were most common finding at presentation in Iranian population with MS. Complementary studies with larger sample size is needed to increase the external validity.

During the past decades, several diagnostic criteria for multiple sclerosis (MS) have been developed and used according to demonstration of lesions disseminated in space and time. The European Multicenter Collaborative Research Network on MRI in MS (MAGNIMS) suggested very interesting and helpful diagnostic criteria for MS in 2010. We believe that these criteria are beneficial since they enhance the way practitioners and researchers deal with clinically isolated syndromes and accelerate their decision making. However, some questions will still remain to be answered in this regard. We think that the addressed challenging points are needed to be remarked in the final guideline to prevent potential misunderstanding in both routine clinical practice and research field.